Endoscopic Retrograde Approach for Trigger Finger Release: A Cadaver Study

Abstract

Summary Trigger finger is one of the most common causes of disability and pain in the hand. Current surgical techniques for trigger finger release fall short in that they are performed blindly with trauma to, or require incision of, the palmar fascia, which can be a source of significant and long-lasting morbidity. Retrograde endoscopic release of the A1 pulley was performed through a single incision at the proximal digital crease in cadaveric specimens. The fingers were then dissected to assess for completeness of release and inspected for injury to nearby structures. Complete release of the A1 pulley was noted in 16 of 16 fingers. No significant injuries to the A2 pulley and flexor tendon were found, and no injuries to the digital nerves or vasculature occurred. The described technique, as demonstrated in cadaveric specimens, is a feasible alternative approach in the treatment of trigger finger. The technique allows complete visualization of A1 pulley release through a single palmar fascia sparing incision.

Single-Incision Endoscopic Trigger Finger Release

“…As such, we believe that moving the surgical incision distally to the base of the proximal phalanx could help to decrease the rates of wound complications in patients, as this area is relatively more recessed and protected. In addition, the more distal incision allows the physician direct visualization of the A2 pulley to ensure adequate protection of it during A1 release to prevent bowstringing 11 …”

“…With growing trends and scientific advancements toward less-invasive surgical options, endoscopic trigger finger release (ETFR) surgeries offer a more minimally invasive method of treatment in comparison to OTFR 9 . The benefits of ETFR for patients may include a reduction in infection rate, stiffness, and recovery time, while also limiting scarring to a more cosmetically preferred location along the palmar-digital crease, 6,11 which has the potential to be a less painful incision location compared with the area overlying the A1 pulley. The perceived benefits of ETFR for surgeons include improved visualization and reduced risk of nerve injury, incomplete releases, infection rates, wound complications, and pain as the palmar fascia is not violated 9,11 .…”

“…The benefits of ETFR for patients may include a reduction in infection rate, stiffness, and recovery time, while also limiting scarring to a more cosmetically preferred location along the palmar-digital crease, 6,11 which has the potential to be a less painful incision location compared with the area overlying the A1 pulley. The perceived benefits of ETFR for surgeons include improved visualization and reduced risk of nerve injury, incomplete releases, infection rates, wound complications, and pain as the palmar fascia is not violated 9,11 . Past ETFR techniques have been reserved for the index, long, ring, and small fingers, and have required the use of 2 incisions 7 .…”

Nonpalmar Endoscopic versus Open Trigger Finger Release: Results from a Prospective Trial

“…Nonpalmar Endoscopic versus Open Trigger Finger Release: Results from a Prospective Trial Original article higher overall satisfaction compared to those treated with standard open release. The feasibility of the technique was demonstrated in cadaveric specimens and published previously 17.…”

“…The feasibility of the technique was demonstrated in cadaveric specimens and published previously. 17 …”